It’s all in the Mind: Psychosomatic and Somatopsychosis
Watching Molly do cartwheels the other day, I discovered a new psychiatric syndrome: somatopsychosis. It’s a very rare condition and she may be the only sufferer largely due to her terrible parent: me.
Most of us are aware of the miraculous power of our minds over our bodies and the inextricable links between psychological problems and physical problems. At the most basic, feeling physically unwell can make us feel sad about not being able to do things we wanted to do, or anxious that we may have a serious or life-threatening illness. Being a medical student was the worst. Reading lists of symptoms of rare neurological diseases was bound to bring on symptoms of blurred vision, pins and needles and lethargy such that a self-diagnosed brain tumour became a convincing reality. Conversely, when we experience bereavement, adversity or tragedy, we often feel it physically as “heartache” or “headache” or “tiredness” and “sleeplessness”. The term “psychosomatic” is basically a fancy way of saying bodily (somatic) symptoms for which there is a psychological (psycho) basis.
Children are no different and due to their immature abilities to identify and express emotions, their propensity to cite psychological problems as physical ones are more frequent. For children, who may have less understanding that psychological problems stem from the head, the gut is the most frequent organ assigned to physical problems. Children who are worried at school may experience genuine stomach aches or constipation which miraculously remit at the weekends and on holidays. For teenagers and adults, the neurological often (but not always) begins to preside with headaches and migraines becoming more prevalent presentations of psychosomatic symptoms.
Psychosomatic symptoms more commonly arise in children who are less able to understand, identify and report their feelings and emotions. Therefore younger children, and children with learning difficulties and or autistic spectrum disorders are more vulnerable. It may also occur in children where reporting feelings and emotions is not possible, discouraged or seen as a sign of weakness or failure. Often children may have experienced past or current physical problems and therefore have a good understanding of how to solicit help or get their needs met for physical problems. Often parents can contribute to symptoms by their own fears and anxieties about their child’s physical health. This is particularly so if the child has a long standing medical condition or has been unwell in the past. Doctors and health professionals can add their own anxieties “of missing a rare disorder” into the mix with repeated investigations and suggested treatments to help uncover and treat an underlying biological basis to problems, and neglect to consider that the underlying problems may be psychological.
If that is the long established thinking on psychosomatic symptoms, what then is my new disorder of “somatopsychosis”? Well, exactly the reverse: psychological symptoms caused by physical ones. This sounds highly unusual, and indeed, Molly is the only recognised case report of this pathological condition that I have just made up. Here is how it works:
Some doctors, like myself (I hope this is the case and I am not an unusually hard-hearted anomaly), have a skewed sense of pain severity due to our dealings with pain at the very severe end. At times it can border on the down-right unsympathetic: when my husband complains of woozy head and sniffles, it’s most definitely man-flu of no significance and he should take Lemsip, go to bed and quit complaining. When an adult patient complains of pain from a blood test, I sometimes mentally think “Come on – it’s a skin prick – I’ve just sewn someone’s entire arm back on!” and don’t let me get started on people that wince in extreme agony from having a blood pressure taken. I am of course professional, kind and sympathetic to my patients, but I am also human, so I hope you will forgive the occasional internal eye-roll at such “wimpish” behaviour.
Unfortunately for my children, professionalism doesn’t wholly apply at home and although broken legs, cuts that are likely to leave scars and high temperatures are met with the usual heightened maternal anxiety (including vivid nightmares of misaligned bones or fractures that disturb the bone growth plates that only people of medical training contemplate) I admit to a general propensity to a lack of sympathy to minor physical pain. As such poor Molly and D have learnt that a grazed knee will earn a dusting off, a quick wound wash, a hug and a wipe of the tears, but then an expectation that the episode is now over and they are to carry on playing. A bumped knee will unlikely earn more than an “Oh dear, you’ll get a nasty bruise” or sometimes, I admit to even worse: “Well, that’s what you get for charging around without looking where you are going.”
As a child psychiatrist on the other hand, identifying and expressing feelings and emotions are a different kettle of fish. From a young age, both children have been encouraged to talk to me about their internal lives, what has worried them at school and all angles are thoroughly investigated and talked through with utmost attention.
It appears that this table-turning of the usual scenario where parents pay immense attention to physical pain and tend to access less of their children’s internal worlds can have its own unhealthy consequences. Here’s what happened:
Molly: Whee! look at me! I can do really good cartwheels now!
Me: You’d better watch out, doing cartwheels on a slippy rug is not the best idea…
Molly: Ouch! [Blubber, blubber]
Me: I told you so.
Molly: You don’t know what a terrible day I had. Girls were being mean to me at school.
Me: [???? What the hell? Where did that come from?]
I had to suppress a smile as I realised what was happening. Molly subconsciously knew that I wasn’t going to give her sympathy for a bumped bottom, but a potential peer interaction problem would give her the comfort and attention she needed at that time of physical pain.
AAARGHH! I have generated somatopsychosis! At least my early recognition of this oddity has reminded me to be more sympathetic to my children and change my ways. I absolutely don’t want her to subconsciously fabricate mental health problems to gain attention. It does go to show though, the frightening power of our day to day words and actions on our children, and the critical importance of what we DO and DON’T give attention and kindness for.
Social hierarchy in 4 year olds
This is part of the infant 360 degree appraisal series on social ability. This post follows on from previous posts on basic,and higher level social ability and will give you information about social hierarchy in 4 year olds. I am not an expert in social anthropology and so the following is just a précis of my own observations using my knowledge of human behaviour and social science that are part and parcel of psychological and psychiatric training.
One of the best places I have found to observe social skill in my children is at a kid’s birthday party, particularly at age 4 years where the tendency is to invite the whole class. Unlike a classroom environment where structure is ever present, and authority stems from the teacher, a birthday party is like the school playground where it is a social free-for-all. In any school assessment we professionals conduct, we always observe the child in the playground as well as in the classroom because, here, and only here, children are left to fend for themselves without adult intervention, it is quite literally a different world.
For a child, the birthday party scenario is one of the most challenging of their social skill. Hell, even as an adult, who does not occasionally quiver in fear at the prospect of having to make small talk with numerable new people at a work do or colleague’s birthday party? Observing how your child copes with this situation is a real test of their social skill in the most difficult of social situations. I had stumbled on this quite by chance by attending numerous kids’ parties, but then my instincts were ratified when I found out that Professor Dale Hay, Professor of Psychology at Cardiff University uses the “Birthday Party Scenario” to assess social skills in children. Her team at the Cardiff Child Development Study, have been hosting mock children’s birthday parties on a weekly basis in their department for the last 7 years. A PhD student is even tasked with appearing at the end of each party in a bear costume! Fab!
Here, not only is it possible to observe your child’s social skill, but also their pecking order in the social hierarchy. Yes, just like in the jungle where our primate relations fight it out to be alpha-male and high-ranking female, so all human societies have a social hierarchy, even amongst 4 year olds. At the top end of the social ability spectrum, the highly socially skilled children battle it out for top-dog status. I was first alerted to this by Big Sis’s nursery teacher. One day, she told me that Big Sis had a bad day at school because “there are some girls in the class with strong personalities and they are clashing for dominance”. It didn’t take me long to figure out that Big Sis was one of the said girls and I made a passing comment about monkeys fighting it out to be alpha-male. I was quite used to the concept of social hierarchy in teenagers and adults. The whole genre of teenage movies from “Pretty in Pink” to “Mean girls” and “High School Musical” are based on the well-established angsts of social hierarchy – but really – does it start in nursery and reception?
The sad answer is “Yes”. After frequenting many of these birthday parties and taking the obligatory shot of the birthday girl/ boy blowing out the candles of their cake, I noticed that in every single picture, the same few children, Big Sis included, were at the birthday child’s side. This happened even when the birthday child was not a particular friend of Big Sis. I began to observe a pattern of “top table children” at birthday parties where the same children would be seated around the birthday child, regardless of whose birthday it was. I developed a theory of social hierarchy being played out in the seating of children at birthday parties. I began to watch these top-table children, and they seem to be extremely socially aware of what is going on. For instance, they anticipate exactly when the call to be seated for food will go out, and where the birthday child is likely to sit (usually somewhere in the middle or at the top end depending on table layout). They then seek to position themselves at the prestigious seats which are those with closest proximity to the birthday child.
Big Sis and her friends were experts at this, but one incident stands out. Big Sis broke her leg and was required to use a zimmer frame to hop around. At a friend’s birthday party, at the all-important call to be seated, there was the usual rush amongst children to sit in proximity to the birthday boy. The table was laid in one long line, and the birthday boy moved to seat himself in the middle. I was observing Big Sis. She saw that all the children ran to seat themselves directly next to the birthday boy and there was a tussle amongst “high-ranking” children here to gain the prestigious seats. She was first to see that the seat opposite the birthday boy, of equal prestige was free and hobbled as quickly as she could on her zimmer frame down to get to the other side. Although she was clearly first off the mark, her able bodied “high-ranking” friends who had missed out on the prime seats next to the birthday boy, had now seen the free seats opposite as she had, and they raced passed her to claim the seats. I had to laugh at this as it proved my theory about birthday seating hierarchy correct. Much to my amazement, when Big Sis got to the seats she had wanted, which were now occupied by her popular friends, she started asking them if she could sit there. Clearly no alpha-child was going to give up their seat, but good-on-her for trying! I felt sorry for Big Sis, as she would certainly have got there first had she not had a broken leg, so in this instance I intervened and I pulled up a chair so she could sit there with her friends. They were happy to make space for her, but I am pretty sure that they may not have done this for all children; girls, even age 4 years are quite good at social exclusion.
In complete contrast, Lil Bro appears devoid of this social antenna. He will without fail ask to go to the toilet just before the call to be seated for food at birthday parties, such that we will emerge from the toilets and he will be sat at the last available seat a mile-away from the birthday child, even if the child is a good friend. Even when he is there, he will stand rooted to the spot until all the other children have sat down before finding the last available seat that nobody else wanted. He appears oblivious to social hierarchy and would even risk being isolated to the cold corner seats at his own sister’s party if I did not reserve a seat for him at his sister’s side. The good thing is that it neither concerns him nor bothers him. I have to admit that occasionally it bothers ME, only because I aspire for him to be super sociable and popular, but then I just have to slap myself in the face, recognise that his needs are different from my wants, see with my own eyes that he is happy and confident and let him BE. Imperviousness to social pressure is also a great strength in itself!
Clearly I have never told my children where to sit at birthday parties, and I doubt anyone ever has, so it is interesting for me to observe the presence and absence of these social instincts in such young children. This ability, termed social osmosis (i.e. picking up knowledge from social experience rather than actively being taught) is thought to be lacking in children with autistic spectrum disorder. Those with excellent social osmosis and social ability are able to climb to the top of the social hierarchy. Their success is not based on physical dominance (aggression), but social dominance – the ability to make friends and influence people. The funny thing is that once you are on the look-out for it, you see examples of hierarchy in 4 year olds all the time.
When I volunteered to go into Big Sis’s class to paint faces, the teacher asked me to choose the first child to have their face painted, and then they were allowed to choose the next child. Whilst painting one girl’s face, her male best friend loitered around saying “please choose me next”. Big Sis had told me that these two classmates were best friends, lived close together and did everything together, so I was not surprised when she smiled, and seemed to agree. Then, out of the blue saunters in “alpha-male”. A bigger, and brighter boy with better social skills. “Please choose me next” he said politely. I smiled, the wicked smile of a child psychiatrist about to test human nature, and asked the fateful question: “So, who do you want to go next?”
The answer is as predictable as it is gut-wrenching , but alpha-male wins every time, and “the boy-next-door” had to wait in line. Social hierarchy in children it seems plays out just as social hierarchy plays out in adults. You only have to observe the parents at children’s birthday parties to see this. But that’s a different story…
Organisational hell – what to pack in a travel handbag
I heard about Cath Kidston’s #totesbig/totessmall campaign and laughed, surely for all parents it’s #totesbig? Mine’s this fetching strong and waterproof Longchamp number.
Carrying large quantities of “vital” stuff around with you all day has never been quite so important as when you have kids in tow. The ante on organisation is raised on having children, purely because logistically, there is so much more that is required to be remembered and carried with you at all times in preparation for all eventualities. We all have a “very organised friend”. Someone who is always on time, never forgets anything and prepares for everything. For me it’s my big sister. When baby Lil Bro yakked up lunch all over himself, and I had not brought a spare baby-gro, who should pull one out of her handbag? Apparently a spare, even though her child no longer wore baby-gros. When we went on a weekend break with the extended family and I forgot to pack towels, who produced a whole spare extra set which she had packed “In case”? Yup, my darling sister. Indeed, whenever I go anywhere with her, I can rest on my laurels as I know that if I have forgotten anything, she will be sure to have “spares”. Thank goodness!
Although I have moments of organisational inspiration (packing a volcano making kit in my suitcase on a holiday to Sicily so I could teach the kids about volcanoes in-situ), at other times I am pitiful. For instance, when Lil bro was a baby I remember joyfully pushing the buggy to my mother-and-baby yoga class in Primrose Hill thinking that I was on time for once, but actually having forgotten the entire meticulously packed Cath Kidston baby changing bag on the table at home. Thankfully, what I lack in organisation, I make up for in practical, can-do attitude. I didn’t miss my yoga class, I just popped into a newsagent. I got some funny looks from the skinny and beautiful Gwyneth types that frequent Triyoga Primrose Hill with their yummy-mummy nappy changing bags, matching cashmere blankets, Sophie giraffes and wooden rattles when I rocked up with nothing for my baby save a 34-for the price of 30 jumbo pack of nappies and a pack of Johnsons’ wet wipes. Well, what more do you need – eh?
At the start of this summer though, I thought that given that I am now a blogger and passing on my worldly (ahem) views on all things parenting, I would write an illuminating blog about all the things “one” should carry in their totes when travelling with young children on holiday. Here is my list:
Bottled water (I know it’s heavy, but always comes in handy)
Snack (usually of the pre-packaged biscuit/ chocolate variety – but on a good organisational skill day, a pair of satsumas)
Like all good doctors, I espouse the sin of sun worshipping, although a little dose here and there to relieve vitamin D deficiency doesn’t do any harm. Still always best to carry sun hats, sun glasses and sun screen with you at all times over the summer hols. A warm waterproof top is meticulously tied around the waist of each child should the weather take a turn (Brits will understand this!).
My kids (like most) are terribly impatient in restaurants, and will not stop asking “When’s the food coming?” as if I have personal telepathy with the kitchens. For distraction purposes, I have found it well worth my while to carry sticker books around with me at all times. In addition, fully equipped pencil cases as pencils and coloured pens can be transformed into any activity: drawing, colouring, noughts and crosses, the shape game (where one person draws a random shape and the other turns it into a picture of something) , pass the portrait (where one person draws a head on a picture, folds it over and passes it to the next person to draw the upper body, then passes it on etc.) and an endless possibility of other games. If we visit a landmark (like a cathedral) or an art gallery, the children will always be asked to draw what they see as this really makes children look carefully, observe and remember what they have seen. I carry 2 of everything because do you think it is possible that they could share? It’s not worth the grey hair.
I know that most people just let their kids use their iphones or ipads, but I am of the old school who fuss and worry about tech getting broken. It comes from my dad’s indoctrination of us in childhood over the perils of biscuit crumbs and spilled milk on the Commodore 64 such that anyone holding food or drink was not allowed within a 3 metre radius of “the expensive computer”. I carry cheap his-and-hers cameras with me to give to the kids to take photos as part of a game or just to see what they find interesting. Looking over pictures they have taken at the end of a day trip is always fun, particularly when you find that the beautiful city of Rouen you visited had nothing more worthy of photographing than a mannequin in a shop front…
The children got “kiddigos” (hand held TV/ games console for little ones) for Christmas last year. As exposure is strictly rationed, the effect of producing the kiddigo is dramatic. The kids are only allowed to use them for the last hour of a long (3+ hours) car journey if they “have been good” during the earlier parts of the journey, and it’s really amazing how well the constant threat of losing the screen time can keep the kids at bay.
So, with all this “well prepared vital stuff” being carted with me everywhere on holiday, you can imagine what a peaceful time we had. It was all going wonderfully smoothly, with hardly a hiccup of “Are we there yet?” or wails of boredom and running up and down in restaurants, until a day trip to the Citadel at Carcassone. We exited the Castle to go home. “I need the toilet” one of them said. “No problem, I’ll take you” I said. Only to find, it was a number 2 of diarrhea proportions. Only to find there was no loo paper in the ladies or the gents. I looked in both.
Despite having a variety of splendid craft and technological activities in my bag and enough sun protection to keep a Scotsman from burning in a dessert, there was no tissue or wet-wipe to be found.
Having unsuccessfully attempted to use pages of the sticker book as toilet paper, it was – OH CRAP – literally.
Well, as I said, what I lack in organisational skill, I make up for in can-do attitude.
Maternal hand it was….
Where was my big sister when I needed her?!